DYSTOk'/A FnoM THE DORSO-LUMnAH rilKSHXTATlOX. 473 



As mentionccl at p. 247, the transverse presentations of the body 

 may be Hniited to two kinds — the dorso-lumbar, in which some part 

 of the back presents at the inlet ; and the stcrno-abdominal , in which 

 the lower part of the body (belly) oilers. 



The foetus may either be Jiorizontal or vertical ; when the former, it 

 may be direct or oblique in direction — i.e., placed perpendicularly or 

 obliquely, with regard to the axis of the mother's body. Saint-Cyr 

 remarks that the first is the most serious, because the extremities of 

 the ovoid fu'tal mass are equally distant from the inlet ; with respect 

 to the other intermediate presentations between the direct longitudinal 

 and transverse, they are evidently less unfavourable because one of the 

 extremities — anterior or posterior, as the case may be — is found nearer 

 the genital canal, so that version is less ditlicult. The oblique presen- 

 tations are almost the only ones compatible with the vertical position 

 of the fa'tus. 



The direct horizontal presentations may be often suspected from the 

 appearance of the mother, the abdomen showing great enlargement 

 laterally ; not unfrequently the movements of the fcctus can be seen on 

 both sides — on the right as well as on the left. 



SKCTION I.— DYSTOKIA FROM THK DORSO-LUMBAR 

 PRKSENTATIDN. 



This presentation is somewhat rare ; the body of the foetus is curved 

 and the limbs ai*e directed forwards. When it is lying horizontally, 

 the fore part may occupy the right or left side of the mother ; hence 

 Saint-Cyr distinguishes them as right or left cephalo-ilial positions — 

 though this does not imply that the fa'tal head is necessarily in con- 

 tact with the ilium, for it may be turned round to one side or bent 

 downwards. 



When the futus is vertical the head is usually uppermost, the hind- 

 quarters being inferior, as in Fig. 147 — Saint-Cyr's ccphnlo-sncral 

 position ; though it may also — for all positions are possible — have this 

 position reversed, the head being downwards and the croup towards 

 the lumbar region of the mother — the ccphalo-abdominal position. 



Cephalo-Ilial Positions. 



To diagnose this cause of dystokia — or back presentation^ — is not 

 always easy. Labour has been going on for some time, the " waters " 

 have escaped, and though the straining may be very energetic — even 

 violent — yet nothing is seen of the fcutus. When the hand is intro- 

 duced into the genital canal, in order to discover the situation of the 

 fcetus and the nature of the obstacle which hinders l;irth, it encounters 

 at first a more or less rounded surface, which does not offer any special 

 character by which it might be recognised. The hand is then passed 

 deeper into the uterine cavity, and turned in every direction over the 

 body of the fa>tus (for such it is), so as to find some parts which may 

 be distinguished, and by which the position of the young creature in 

 the uterus may be learned. 



By this methodical exploration, the obstetrist recognises that the 

 body of the foetus is more or less curved in the back, one of the regions 

 of which presents at the inlet ; while the head and limbs, more or less 

 entangled with each other, and more or less accessible to the hand, are 



